MARC Primary Therapist Tyler Howard’s experience implementing telehealth therapeutic solutions in the midst of COVID-19

The social distancing and self-quarantine practices for “flattening the curve” have forced many mental health and addiction treatment professionals to adapt to telehealth, however begrudgingly. I remember this topic being particularly contentious in graduate school, although our conversations never considered that we might experience a global pandemic in our lifetimes. How could a client get the full healing power of a safe space and a listening ear through a screen? What about the important facial cues and body language that we might miss while making sure we are in the computer frame? How can we freely share resources when distanced miles apart from each other? Like it, love it, or hate it, it’s here to stay. I have been working from home the past week, facilitating individual therapy, family therapy, and group therapy groups. These are the top five lessons I have learned from the telehealth learning curve, as Maryland Addiction Recovery Center switched over to telehealth services for our intensive outpatient (IOP) patients in order to still offer services while supporting the global health initiative of social distancing:

1) Clients adapted almost seamlessly to the new format. I was terrified being the guinea pig for our first “IOP Online” therapy group, and assumed that distractions, distance, and feelings of disconnection would set the group back in terms of cohesiveness and investment. I couldn’t have been more wrong! They quickly came together to create a list of “telehealth expectations and etiquette” that they asked to review at the beginning of every group. We have revisited the list and added new topics as they arise (more on that in #5). Examples include setting up laptops in private rooms and keeping headphones on to protect confidentiality, never stopping the video or walking off screen outside of group breaks (i.e. did you walk to the other side of your room, or leave your house entirely?), and keeping the room well-lit so we can read body language and facial expressions.

2) Clients create structure and consistency for themselves, with therapist support and empowerment. I have been inspired and encouraged by how clients enforce these expectations with their peers with little to no prompting by me as the therapist. “Dude, your forehead looks great, but I want to see your eyes when I’m sharing vulnerably” and “It feels like I’m challenging you, but your room is nearly pitch black, and it feels that you don’t want to be seen by me” are two examples of clients empowering themselves to provide guidance and structure. I am privileged to see it unfold in the moment, and to reinforce it when appropriate. Clients are also working harder than ever with their families, peers, and sober supports to set up regular communication. One family I work with is doing an online “Mafia” game with family all over the United States; another patient set up a Cards Against Humanity game with his sponsor and sober supports for Friday night after their online recovery meeting.

3) Clients love the digital resources. We utilize Zoom for telehealth, and I was floored when my mid-60s client taught ME how to screen share on the platform that first night of online groups. I have been able to adapt groups that involved movement in the physical space, drawings on the white board, or utilizing the television in the MARC group therapy room by representing that digitally on my laptop. We have watched Ted Talks, identified emotionally by analyzing art, gone through psychoeducational power points, and more using this feature.

4) Clients feel more connected and cohesive than ever before. A major worry I had last week is that without the physical closeness, we would lose emotional closeness and connection. I could not have been more wrong. These folks desperately want their peers to feel as plugged in with recovery as they do, and are checking in with each other through groups, texts, video chat, etc. I love muting my microphone and ending video sharing for group break, but hearing clients elect to stay on screen to share recipes, guitar skills, and music recommendations. I have BCC-ed clients on emails to send out group activities, and after group I am met with replies asking me to send out google drive links to online recovery meetings and psychoeducational websites. 

5) Clients are adjusting to the learning curve as well. Last week, I listened in horror to a client using the restroom during group break. They remembered to end the video (thank GOD) but did not mute the microphone. A client this week was confused when I addressed him for taking off his shirt in the middle of discussion. “But I’m at home!” he said. “I never wear pants at home, why do I have to wear a shirt if I’m in my bedroom.” Which leaves me to figure out how to document that in a group note…. #serenityprayer

Therapists and clients alike: embrace the power of technology in providing critical mental health and addiction support in these unprecedented times, but if there is one thing I would like to stress over everything else…PLEASE wear pants.

Maryland Addiction Recovery Center is proud to be taking the necessary steps in order to continually offer life-saving addiction and co-occurring treatment to those in need while supporting our community, our society, and our frontline healthcare workers through the act of social distancing. We have implemented virtual intensive outpatient (IOP) treatment for all patients in our IOP programs, as well as continuing to serve the health and safety of our patients through the recommended protocols put forth by the CDC.

If you or someone you know needs help for addiction or co-occurring disorder issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at For more information on all of our drug addiction, alcohol addiction and co-occurring disorder services and recovery resources, please visit our web site at